This biography examines the life of Dr. Alexander Hamilton, a highly educated Scottish physician who immigrated to Maryland in 1738. From an elite European family, Hamilton was immediately confronted with the relatively primitive social milieu of the New World. He faced unfamiliar and challenging social institutions: the labor system that relied on black slaves, extraordinarily fluid social statuses, distasteful business methods, unpleasant conversational quirks, as well as variant habits of dress, food, and drink that required accommodation and, when possible, acceptance. Paradoxically, the more acclimated he became to Maryland ways, the greater the motive to change that society and make it more satisfying for himself both emotionally and intellectually. Breslaw perceptively describes the ways in which Hamilton tried to transform the society around him, attempting to recreate the world he had left behind and thereby justify his continued residence in such an unsophisticated place.